Abstract Details

Purpose:

To evaluate the functional and anatomical outcome of intravitreal ranibizumab treatment in eyes with diabetic macular edema (DME) having persistent edema unresponsive to initial therapy with intravitreal bevacizumab.

Eyes with persistent DME following at least 4 previous consecutive bevacizumab injections prior to ranibizumab treatment were included. To be enrolled, the last 3 bevacizumab injections had to be provided in 4-6 weeks interval, and at least 12 months of follow up must have been recorded.

Results:

202 eyes were included. Patients received a mean (±SD) of 8.8±4.9 bevacizumab injections over 15.7±12 months prior to the switch to ranibizumab. 7±2.7 ranibizumab injections were provided during the 12 months following the switch to ranibizumab. The median central subfield thickness (± interquartile range) according to SD-OCT reduced from 436.0±162.0 micron at baseline to 318.5±113.0 micron at month 12 (p<0.001). The macular thickness reduced in 133 (65.8%) of the eyes by 10% or more, and in 72 of the eyes (35.6%) by 25% or more from the pre-ranibizumab value, respectively. In 15 eyes (7.4%) the macular thickness increased by 10% or more, and in 8 eyes (3.9%) macular thickness increased by 25% or more. Median logMAR visual acuity (± interquartile range) improved from 0.40±0.48 at baseline to 0.38±0.40 at month 12 (p=0.001). There was correlation between the visual acuity prior to the switch and the change in visual acuity following the switch (r=0.344, p<0.001; Spearman correlation). Vision improved by ≥1 ETDRS-line equivalent in 72 eyes (35.6%) and by ≥3 lines in 32 eyes (15.8%); vision decreased by ≥1 line in 37 eyes (18.3%), and by ≥3 lines in 13 eyes (6.4%).

Conclusions:

The DERBI study demonstrated that ranibizumab therapy in eyes with persistent DME despite prior bevacizumab therapy may be associated with both functional and anatomical improvement.